With about two months to go for launch of NHPS, its model tender document leaves several questions unanswered

From this author

With about two months to go for the NHPC’s launch, it is disquieting that the government has not yet managed to address them convincingly. (editorial)

Finance Minister Arun Jaitley’s Budget speech positioned the National Health Protection Scheme (NHPS) as the big idea whose time has come. He introduced it as the “world’s largest health protection plan” and said that it would cover 50 crore individuals from nearly 10 crore poor and vulnerable families.

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But immediately after the announcement, questions were raised over the capacity of the country’s healthcare system to handle a project of such proportions. There were also apprehensions that private hospitals would milk the NHPS by prescribing unnecessary investigations. The Model Tender Document For The Selection of Implementing Agencies For the NHPS, released by the Union Ministry of Health and Family Welfare on Wednesday, tries to address some of these concerns.

The document states that nearly 47 per cent of the packages under the NHPS, including those related to heart ailments and cancer, require pre-authorisation. In other words, hospitals empanelled under the scheme cannot perform these procedures until they have an authorisation letter from the NHPS’s Implementation Support Agency. Given that the scheme’s predecessor, the Rashtriya Swasthya Bima Yojana, was riddled with unethical practices such as unnecessary hospitalisation, needless investigations and billing for superfluous and unrelated treatment packages, checks on the empanelled hospitals are well in order.

However, in the absence of protocols for diagnostic tests for beneficiaries of publicly-funded insurance schemes, any authorisation process can only be arbitrary. More worryingly, there is little in the model document that prevents hospitals from shifting the onus of obtaining the authorisation letter on the critically-ill or their families. This omission could defeat the NHPS’s primary objective of “improving access of identified families to quality inpatient care and day-care surgeries”.

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Several procedures, including emergency consultation for acute colic, nebulisation for an asthma attack, hypoglycaemia in a diabetic and treatment of “dengue without complication”, will be covered by the scheme only if the treatment is availed in a government hospital. Such ailments can indeed be taken care of at a primary health centre (PHC). But given that there is one government doctor for more than 1,000 people, one state-run hospital for more than 90,000 people and a 22 per cent shortage of PHCs in the country — according to the Union Ministry of Health and Family Welfare — a seemingly uncomplicated procedure such as nebuliser treatment for asthma most often necessitates a visit to a private healthcare provider.

Without timely treatment, a dengue fever can aggravate to a life-threatening disease. Such concerns were raised when the scheme was announced. With about two months to go for the NHPC’s launch, it is disquieting that the government has not yet managed to address them convincingly.